Provider Demographics
NPI:1184603870
Name:SMITH, NEIL WALTER (PHD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WALTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W 23RD ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2496
Mailing Address - Country:US
Mailing Address - Phone:212-337-8866
Mailing Address - Fax:718-816-6913
Practice Address - Street 1:171 W 23RD ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2496
Practice Address - Country:US
Practice Address - Phone:212-337-8866
Practice Address - Fax:718-816-6913
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010132103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01202437Medicaid
NY01202437Medicaid